We examined whether the incidence of pruritus following the administration of epidural morphine during combined spinal and epidural anesthesia (CSE) differs according to the length of the epidural catheter inserted. We divided 40 patients who received obstetric or gynecological surgery into two groups according to the distance of epidural catheter : at 3 cm (CSE-3) and 6 cm (CSE-6). A larger number of patients in the CSE-3 group complained of pruritus (9 patients [45%]) significantly compared to the CSE-6 group (4 patients [20%]). There were no other significant differences between the two groups. We conclude that the incidence of pruritus produced by epidural morphine during CSE by single-place technique differs according to the length of the epidural catheter inserted, and recommend that the epidural catheter be inserted further into the epidural space.

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The efficacy of low level laser irradiation around the superior cervical ganglion (SCG) combined with stellate ganglion block (SGB) using 7ml of 1% lidocaine for patients with sudden hearing loss (SHL) was estimated according to the recovery criteria of the official committee of SHL, Japan. The outcome was evaluated according to the following four criteria ; 1) Complete recovery <20dB in all tested frequencies ; 2) Remarkable return to average pure tone score of >30dB ; 3) Effective return to average pure tone score of >10dB ; and 4) Ineffective. The recovery rate was significantly (p<0.01 by Mann-Whitney test) elevated in the SGB + laser irradiation group (n=64), as compared with those of the SGB-alone group (n=62) ; i.e. 1) =30% and 4) =8% in the SGB + laser irradiation group vs. 1) =11% and 4) =27% in the SGB-alone group. Sympathetic nerve fibers around distal vessels of the proper cochlear artery mainly originate from the SCG, which would regulate blood flow of cochlear arterioles. Therefore, laser irradiation of the SCG combined with SGB was considered to be more effective than SGB alone owing to sympathetic blockade in the wider area.

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We report a case of an anesthetic ventilator malfunction by an unusual cause. A 77-year-old male with lumbar disk herniation was scheduled for discectomy and laminectomy. Anesthesia was maintained with sevoflurane, N₂O, O₂ and fentanyl using a semiclosed circuit system. The patient was ventilated using a KMA-1300F anesthetic machine (ACOMA Co.). A few minutes after induction of anesthesia, airway pressure suddenly rose to over 40cmH₂O. Tidal volume was reasonable and overly great chest pressure was not found. The airway pressure returned to a normal level with manual ventilation. Because we could not find the cause of the ventilator failure, anesthesia was maintained using another anesthetic machine until the completion of the surgery. After the surgery, we found that the solenoid valve was fixed in inspiratory phase. The cause of the solenoid valve malfunction was the electric system trouble. This trouble may suddenly occur and be unable to be discovered with periodic inspection. In conclusion, it is necessary for anesthesiologists to understand the inner structure of the anesthetic machine and solenoid valve troubles should be suspected when airway pressure suddenly rises using an old anesthetic machine.

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A combination of amitriptyline and valproate has been shown to be an effective treatment for postherpetic neuralgia (PHN). We treated six cases of neuropathic pain successfully with these two drugs. There were five cases of herpes zoster and PHN and one case of arteriosclerosis obliterans (ASO), in which obstruction of grafting might have caused nerve damage. Epidural block, sympathetic ganglion block and linear polarized near infrared ray irradiation near the stellate ganglion showed effects to some extent on the neuropathic pain in all cases. Concomitant use of amitriptyline and valproate gave almost complete pain relief in all the cases while only amitriptyline did not give effective pain relief. In five herpetic patients pain completely disappeared, so the treatment of drugs was stopped. In all six cases valproate seemed to act on neuropathic pain in a different way from amitriptyline.

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We reported anesthetic management of a 4-year-old girl of Cornelia de Lange syndrome who underwent a laparoscopic fundoplication. As problems of the management, we recognized difficult endotracheal intubation, and pneumothorax caused by accidental diaphragm injury. The difficult intubation was overcome by an intubation technique guided with a fiber optic bronchoscope. The diaphragm injury caused severe ventilation failure, which resulted in discontinuance of pneumoperitoneum. While laparoscopic surgeries are supposed to be applied to patients with unfavorable conditions like this patient, careful airway management under adequate monitoring is needed.

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